title: Postoperative pancreatic fistula formation according to ISGPF criteria after D2 gastrectomy in Western patients.
abstract: BACKGROUND
  Limited information is available on the incidence of postoperative pancreatic fistula (POPF) after D2 gastrectomy with the strict use of the International Study Group of Pancreatic Fistula (ISGPF) criteria, particularly so in Western patients.
  
  
  METHODS
  All patients who underwent gastrectomy for adenocarcinoma at the Karolinska University Hospital Huddinge from 2006 until June 2012 were identified via hospital records and reviewed for type of surgical procedure, postoperative morbidity, incidence, and risk factors for POPF.
  
  
  RESULTS
  Ninety-two of 107 cases had a D2 gastrectomy eligible for evaluation of POPF, of which 83 (90 %) also underwent bursectomy. Seven patients fulfilled the criteria for POPF grade A (7.6 %), 5 met the criteria for POPF grade B (5.4 %), and 6 the criteria for POPF grade C (6.5 %). The incidence of POPF grade B or C was 4.9 % among the 82 patients for whom no pancreatic resection was performed and 70 % among 10 cases with concomitant pancreatic resection. The latter (OR 156.2, 95 % CI 8.00-3046.93) and age (OR 1.2, 95 % CI 1.02-1.35) were found to be the only risk factors for POPF after gastrectomy upon a multivariate analysis.
  
  
  CONCLUSIONS
  In this series of Western patients, POPF grade B or C according to the ISGPF criteria was uncommon after D2 gastrectomy without pancreatic resection. Bursectomy was not a risk factor for POPF.
authors.affiliation: Department of Clinical Science, Intervention and Technology, Division of Surgery, Karolinska Institutet and Karolinska University Hospital, Huddinge, GastroCentrum kirurgi K53, 141 81, Stockholm, Sweden.
authors.forename: Chih-Han
authors.initials: CH
authors.lastname: Kung
authors.forename: Mats
authors.initials: M
authors.lastname: Lindblad
authors.forename: Magnus
authors.initials: M
authors.lastname: Nilsson
authors.forename: Ioannis
authors.initials: I
authors.lastname: Rouvelas
authors.forename: Koshi
authors.initials: K
authors.lastname: Kumagai
authors.forename: Lars
authors.initials: L
authors.lastname: Lundell
authors.forename: Jon A
authors.initials: JA
authors.lastname: Tsai
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010185:Pancreatic Fistula / Q000453:epidemiology* / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000473:pathology; D012307:Risk Factors; D013274:Stomach Neoplasms / Q000473:pathology / Q000601:surgery*